Toward a Derived Theory of Patient Satisfaction
Comley, Anita L., Beard, Margaret T., Journal of Theory Construction and Testing
Abstract: As health care providers compete in a more consumer-driven environment, understanding the phenomenon of patient satisfaction has gained greater importance. The purpose of this paper is to utilize the strategy of theory derivation to build a theoretical model of patient satisfaction with nursing care from existing theories of job satisfaction. Following a careful review of the patient satisfaction literature and a brief overview of job satisfaction theory, analogies between the two phenomena are identified. Transposition of concepts and relationships from two existing theories of job satisfaction facilitates construction of a proposed theory of patient satisfaction. Implications for research are discussed, including an example of the use of a substantive theory to test relationships of the model.
Key Words: patient satisfaction, job satisfaction, theory deriveration
The strategy of theory derivation utilizes an analogy or metaphor to transpose explanations or predictions about a phenomenon from one field of study to another. This strategy is useful in the study of a phenomenon that has little existing theoretical framework. Theory derivation begins with the analysis of the phenomenon, including careful review of the literature on the topic. The next step is to read widely from other fields in hopes of discovering analogies or insights into ways of explaining or predicting about the phenomenon. Once a parent" theory is chosen from a related field, those components of the theory that are useful for explaining the phenomenon in question must be discerned. Any useful concepts or relationships may then be redefined to increase their meaningfulness in the field of the theorist (Walker & Avant, 1988).
The purpose of this paper is to utilize the strategy of theory derivation to identify useful concepts and relationships in two existing theories of employee satisfaction from the field of organizational behavior to build a theoretical model of patient satisfaction with nursing care. Implications for research are discussed, including an example of the use of a substantive theory to test relationships of the model.
Defining the Concept of Patient Satisfaction
Bowling (1992), Bond and Thomas (1992), Fitzpatrick (1990) and Thompson, Webster and Meddis (1990) agree that patient satisfaction is a frequently used, nonspecific measure of outcomes that is rarely analyzed, citing a literature search of almost one hundred references to patient satisfaction in which only one author attempted to define the term.
A current survey of the nursing and allied health literature revealed a variety of operational definitions. Some of these definitions are stated in terms of patient attitudes and perceptions. Cleary and McNeil (1988) define it as the "cognitive and emotional reaction to experiences of health care; it is a measure of attitudes." Donabedian (1988) states that patient satisfaction is a "subjective perception from the patient's point of view that the caregivers must view as reality". Hinshaw and Atwood (1982) operationalized the term for their revision of Risser's (1975) Patient Satisfaction Instrument as "the patient's attitude toward the nursing staff and the care received from the nursing staff." Linder-Pelz (1982) proposed that satisfaction was a positive attitude based on the patient's belief that care has certain attributes and his/her evaluation of those attributes. She defined patient satisfaction as "positive evaluations of distinct dimensions of the health care".
Many authors define patient satisfaction in terms of the degree to which patient expectations are fulfilled (Abramowitz, Cote & Berry, 1987; Greeneich, 1993; Williams, 1994). One of the earliest, Risser (1975), defined the concept as the match between patient expectations of nursing care and the care actually received. More recently, Hill (1997) developed the Leeds Satisfaction Questionnaire based on patient satisfaction as "the degree to which patients perceive their needs are met". …